Newsletter - Bartlett Regional Hospital

VBAC, continued from page 2
As ACOG’s guidelines make clear, labor
after cesarean section can only be safely
undertaken in a facility that has sufficient
surgical and pediatric resources
to provide the full suite of emergency
services that can be necessary if a VBAC
were to result in life threatening complications.
Bartlett Regional Hospital is a small
community hospital. We have excellent
but limited obstetrical and surgical
services. The nearest neonatal intensive
care units are in Anchorage and Seattle.
Several possible complications can
occur with VBAC, including rupture
of the uterus. ACOG’s position states
that there are no accurate predictors in
labor for uterine rupture, and if a facility
cannot provide immediate neonatal
emergency care, women should be
referred to the closest facility that can
provide such services.
Risks of uterine rupture include:
• Permanent injury to baby
• Need for removal of mother’s
uterus (hysterectomy)
• Damage to mother’s bowel or
bladder
• Severe hemorrhage requiring
blood transfusion to mother or
baby
• Severe infection of mother or
baby
While the risk of such uterine rupture
is low—less than one percent— the
potential outcomes can be catastrophic
and can occur quickly.
Time is critical in recognizing and
managing this complication to prevent
permanent brain damage to the baby.
In such instances, the lives of both the
mother and baby are at great risk. No
one knows exactly how much elapsed
time is acceptable, but we do know
that delivery needs to occur in a matter
of minutes. Bartlett does not have the
benefit of anesthesiologists and surgical
teams assigned exclusively to obstetrics,
so every minute of delay could lead to
severe complications.
We understand that many women want
VBACs. We also understand that relocating
from home late in pregnancy is
disruptive, but we fully support Juneau
doctors who feel it is the safest option
for women in Bartlett’s service area
wishing to attempt VBAC deliveries.
If a woman is considering VBAC delivery,
we recommend that she and her
doctor have a thorough discussion
about it early in pregnancy. Not everyone
is a good VBAC candidate and an
early discussion can make planning
the delivery in a larger hospital easier
to facilitate. Discussing your options
and risks with your doctor is critically
important.
Bartlett Regional Hospital will continue
to provide high quality obstetrical care.
Our goal is to provide maximum safety
for both mother and baby. We therefore
encourage interested women to pursue
VBAC at facilities designed to accommodate
her circumstance. Your physician
will be more than happy to discuss
with you other choices of facilities.
On a mission — for
children treated at
Bartlett Regional
Hospital. Thanks to
the annual Toy Run
by members of the
Southeast Alaska
Panhandlers Motorcycle
Club, every child who
receives treatment at
Bartlett also receives
a toy.
HouseCalls — 18